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Digestive Disorders Message Board


Digestive Disorders Board Index


Monday morning, I started feeling a little nauseous. Just a little. On a nausea scale from 1-10, I'd say about a 1 or a 2 -- enough to notice it, but not enough to keep me from working. Yesterday, when I went to lunch with a friend, I commented on the nausea which I still had that morning. It didn't prevent me from have a big lunch. However, right after lunch I felt bloated and not entirely well. Again, it wasn't enough to keep me from doing anything. However, after that lunch yesterday, I have yet to regain my appetite in spite of not having had anything to eat since then. This is very unusual for me. I either eat like a pig or try hard not to (although I am at a healthy weight: 5' 5" and 115 lbs). Also, ever since last night, I have had a kind of malaise and a subjective fever (feels like I have a fever, but doesn't show up on the thermometer as such). I've had no diarrhea, no abdominal pain, no vomiting.

If that were it, I wouldn't worry too much or be thinking about what to do. However, over the last 1 1/2 years or so I have been having regular blood tests to monitor my reaction to an immunosuppressant I'm taking in a relatively low dose for an autoimmune disease. I've never had the results come back normal. The lipase has always come back too high. Not extremely high, but between 78 and 144 U/L where the upper limit of normal in my lab is 60 U/L. I've never had any symptoms/side effects. Last time I saw my rheumatologist, he expressed a little concern in spite of my total lack of side effects and suggested that next time I also be tested for amylase. He reassured me that the amylase would probably be normal and we could breathe a sigh of relief and proceed from there.

Well, I had my 3-month blood test done last Thursday (before I was feeling sick) this time with both lipase and amylase on the order (in addition to the standard liver panel and CBC). I got the results yesterday evening (I can get them on-line), a day and a half after I started feeling sick. I was concerned to see that the lipase was higher than it has ever been at 177 (almost 3x the upper limit of normal) and that the amylase was also elevated at 118 U/L where the upper limit of normal is at 101 (so only slightly elevated).

I'm concerned about this "illness" for a couple of reasons:

First, it's unlike anything I've ever had before. I'm fortunate in that I tend to either feel 100% healthy or obviously quite ill, at least where my digestion is concerned. That is, I do not have a history of vague abdominal complaints/slight illness. I have a long history of recurrent diverticulitis with over 10 attacks over the last 15 years (even after preventative abdominal surgery), however each attack has been far from subtle. More like excruciating. Also whenever I've had gastroenteritis or food poisoning, the symptoms were also a lot more obvious. As far as I can recall, this is an entirely new experience.

Second, I'm wondering if it's associated in any way with the rise in my lipase readings on Thursday's blood test and/or linked to the medication I'm taking. One obvious way to see if it's linked to the medication is to stop the meds, but I really do not want to do this for a variety of reasons. I'm also wondering if my chronically high lipase is due to some background/asymptomatic diverticular disease instead of the medication. Or maybe it has nothing to do with either. Maybe I just typically have relatively high concentration of enzyme lipase in my blood and the high readings are a red herring.

I happen to have two medical appointments already on the calendar for next week, one with my PCP and one with my rheumatologist, so expert opinion will not be long in coming.

In the meantime, these are my possible self-diagnoses:

* A much milder form of diverticulitis than I usually get. I have been much better about my diet and having been taking a lot of high-powered probiotics, so maybe this is my reward -- non-excruciating flare-ups.

* Some kind of stomach bug with very mild symptoms that is lingering for whatever reason.

* A reaction to the medication I've been taking for 1 and 1/2 years. But why would I have a reaction now?

* A gastric or duedenal ulcer. The symptoms seem to be more related to my upper GI tract and although I don't have any pain, I seem to feel the most discomfort when I press on my upper abdomen in the middle. Also, I've read that moderately elevated lipase and amylase can be associated with ulcer, or with gallbladder disease or kidney disease. It's not as specific to the pancreas as highly elevated lipase.

* Finally, of course, some kind of cancer. The fact that my symptoms are mild actually makes me worry about this a little more than if they were more pronounced. When I first started getting my unusually high lipase readings, my PCP suggested that I might have pancreatic cancer. I scoffed at him then (I actually thought he was irresponsible and scare-mongering for bringing this up), but now of course am worried. I know that the incidence of pancreatic cancer goes up with age, and I am 53. Also, I have had one other very strange episode about 6 months ago that included what I thought might have been PC symptoms. I had been drinking a lot more than I usually do (2 glasses a day for about 5 days vs. next to none). I decided to stop with the drinking because I felt like I was getting a little out of control (for me). About 24 hours after my last glass, I got really sick in a bizarre way. Among other things, I had intense itching all over my body. However, I was back to normal within 4 hours.

So, what to do?

* Call my rheumatologist? I'm really curious to see if my lipase and amylase readings are higher now that I'm having symptoms. I think it's somewhat of a no-brainer to call my rheumatologist and ask him if he can order me another blood test soon so we can see if there is any correlation. So, I'm probably going to do this.

* Make an appointment with my GI? Should I or should I wait a while? After all, I've only been feeling sick for a couple of days, but then again, there are the increasingly elevated lipase and now amylase readings.

* Make an appointment with my PCP? I'm actually in the process of switching primary care doctors. I have a new patient appointment with the new one next week. I could go to the old one though, although I don't like him that much (why I'm switching).

* Should I try to eat something even if I'm not feeling that hungry? Or should I just wait until I feel hungry?

* Should I take it easy and rest? Or push through? Or something in between? (I have no pressing deadlines at the moment).

Ideas?
[QUOTE=Melisande1;5461624]Monday morning, I started feeling a little nauseous. Just a little. On a nausea scale from 1-10, I'd say about a 1 or a 2 -- enough to notice it, but not enough to keep me from working. Yesterday, when I went to lunch with a friend, I commented on the nausea which I still had that morning. It didn't prevent me from have a big lunch. However, right after lunch I felt bloated and not entirely well. Again, it wasn't enough to keep me from doing anything. However, after that lunch yesterday, I have yet to regain my appetite in spite of not having had anything to eat since then. This is very unusual for me. I either eat like a pig or try hard not to (although I am at a healthy weight: 5' 5" and 115 lbs). Also, ever since last night, I have had a kind of malaise and a subjective fever (feels like I have a fever, but doesn't show up on the thermometer as such). I've had no diarrhea, no abdominal pain, no vomiting.

If that were it, I wouldn't worry too much or be thinking about what to do. However, over the last 1 1/2 years or so I have been having regular blood tests to monitor my reaction to an immunosuppressant I'm taking in a relatively low dose for an autoimmune disease. I've never had the results come back normal. The lipase has always come back too high. Not extremely high, but between 78 and 144 U/L where the upper limit of normal in my lab is 60 U/L. I've never had any symptoms/side effects. Last time I saw my rheumatologist, he expressed a little concern in spite of my total lack of side effects and suggested that next time I also be tested for amylase. He reassured me that the amylase would probably be normal and we could breathe a sigh of relief and proceed from there.

Well, I had my 3-month blood test done last Thursday (before I was feeling sick) this time with both lipase and amylase on the order (in addition to the standard liver panel and CBC). I got the results yesterday evening (I can get them on-line), a day and a half after I started feeling sick. I was concerned to see that the lipase was higher than it has ever been at 177 (almost 3x the upper limit of normal) and that the amylase was also elevated at 118 U/L where the upper limit of normal is at 101 (so only slightly elevated).

I'm concerned about this "illness" for a couple of reasons:

First, it's unlike anything I've ever had before. I'm fortunate in that I tend to either feel 100% healthy or obviously quite ill, at least where my digestion is concerned. That is, I do not have a history of vague abdominal complaints/slight illness. I have a long history of recurrent diverticulitis with over 10 attacks over the last 15 years (even after preventative abdominal surgery), however each attack has been far from subtle. More like excruciating. Also whenever I've had gastroenteritis or food poisoning, the symptoms were also a lot more obvious. As far as I can recall, this is an entirely new experience.

Second, I'm wondering if it's associated in any way with the rise in my lipase readings on Thursday's blood test and/or linked to the medication I'm taking. One obvious way to see if it's linked to the medication is to stop the meds, but I really do not want to do this for a variety of reasons. I'm also wondering if my chronically high lipase is due to some background/asymptomatic diverticular disease instead of the medication. Or maybe it has nothing to do with either. Maybe I just typically have relatively high concentration of enzyme lipase in my blood and the high readings are a red herring.

I happen to have two medical appointments already on the calendar for next week, one with my PCP and one with my rheumatologist, so expert opinion will not be long in coming.

In the meantime, these are my possible self-diagnoses:

* A much milder form of diverticulitis than I usually get. I have been much better about my diet and having been taking a lot of high-powered probiotics, so maybe this is my reward -- non-excruciating flare-ups.

* Some kind of stomach bug with very mild symptoms that is lingering for whatever reason.

* A reaction to the medication I've been taking for 1 and 1/2 years. But why would I have a reaction now?

* A gastric or duedenal ulcer. The symptoms seem to be more related to my upper GI tract and although I don't have any pain, I seem to feel the most discomfort when I press on my upper abdomen in the middle. Also, I've read that moderately elevated lipase and amylase can be associated with ulcer, or with gallbladder disease or kidney disease. It's not as specific to the pancreas as highly elevated lipase.

* Finally, of course, some kind of cancer. The fact that my symptoms are mild actually makes me worry about this a little more than if they were more pronounced. When I first started getting my unusually high lipase readings, my PCP suggested that I might have pancreatic cancer. I scoffed at him then (I actually thought he was irresponsible and scare-mongering for bringing this up), but now of course am worried. I know that the incidence of pancreatic cancer goes up with age, and I am 53. Also, I have had one other very strange episode about 6 months ago that included what I thought might have been PC symptoms. I had been drinking a lot more than I usually do (2 glasses a day for about 5 days vs. next to none). I decided to stop with the drinking because I felt like I was getting a little out of control (for me). About 24 hours after my last glass, I got really sick in a bizarre way. Among other things, I had intense itching all over my body. However, I was back to normal within 4 hours.

So, what to do?

* Call my rheumatologist? I'm really curious to see if my lipase and amylase readings are higher now that I'm having symptoms. I think it's somewhat of a no-brainer to call my rheumatologist and ask him if he can order me another blood test soon so we can see if there is any correlation. So, I'm probably going to do this.

* Make an appointment with my GI? Should I or should I wait a while? After all, I've only been feeling sick for a couple of days, but then again, there are the increasingly elevated lipase and now amylase readings.

* Make an appointment with my PCP? I'm actually in the process of switching primary care doctors. I have a new patient appointment with the new one next week. I could go to the old one though, although I don't like him that much (why I'm switching).

* Should I try to eat something even if I'm not feeling that hungry? Or should I just wait until I feel hungry?

* Should I take it easy and rest? Or push through? Or something in between? (I have no pressing deadlines at the moment).

Ideas?[/QUOTE]





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